complications
These are the three classic microvascular complications of diabetes
What are retinopathy, nephropathy, and neuropathy
State all four tests/cut-off points that can diagnose diabetes.
what are A1C ≥6.5%, FPG ≥126 mg/dL, 2-h PG ≥200 mg/dL on 75-g OGTT, or random glucose ≥200 mg/dL with classic symptoms/hyperglycemic crisis?
interval screening (age/timing) recommendations for:
- general population
- uncontrolled T2DM
- Controlled
1) what is 35 years old? what is every 3 years? or at what is at any age for overweight individuals with any risk factor?
2) what is every 3-6 months?
3) what is at least every 6 months?
After optimizing basal insulin, prandial insulin is first added before this meal.
what is the largest meal of the day?
This dual-mechanism weekly injectable stimulates insulin release, suppresses one pancreatic hormone, and suppresses appetite; acting simultaneously as a GLP-1 receptor agonist and an agonist at glucose-dependent insulinotropic polypeptide receptor
What is tirzepatide
In a T2DM patient on an SGLT2 inhibitor after an alcohol binge with poor intake, an anion-gap acidosis with ketones but glucose <200 mg/dL points to this under-recognized diagnosis.
What is euglycemic diabetic ketoacidosis?
Pearl: up to a third present with glucose <200 mg/dL
For T2DM with heart failure of either reduced or preserved ejection fraction, this drug class is recommended for glycemic control and prevention of HF hospitalizations, independent of A1C
What are SGLT2 inhibitors
Type 1 diabetics should be referred to ophthalmology within this many years of diagnosis - and explain in one sentence why this timeline differs from type 2 diabetics.
What is 5 years - because type 1 diabetics typically have a defined onset and less microvascular damage at diagnosis, whereas type 2 diabetics often have years of undiagnosed hyperglycemia already causing retinal damage by the time of diagnosis?
This is the recommended insulin naive starting dose of basal insulin, expressed either as a flat dose or by body weight
What is 10 units/day (or 0.1–0.2 units/kg/day)?
This oral medication remains the cornerstone of T2DM therapy, reduces A1C by ~1.5%, but should not be started if GFR is below this value
What is metformin (GFR <45, contraindicated <30)?
SGLT2 inhibitors are not approved in this diabetes type because DKA risk is 5-17 times higher, occurring in roughly 4% of these patients.
what is type 1 diabetes?
the most effective method for preventing T2DM
(provide details)
Lifestyle modification ---- weight loss of 5-10% and physical activity of 150 minutes/week has been shown to be more effective than other measures at preventing diabetes in those at increased risk of diabetes
After one or more normal annual dilated eye exams in a person with type 2 diabetes whose glucose is at goal and who has no retinopathy, the 2026 ADA Standards say screening may be stretched to this interval - but any level of retinopathy reverts screening to this shorter interval
What is every 1-2 years (no retinopathy, at goal) versus at least annually once any retinopathy is present?
This dual GIP/GLP-1 receptor agonist is now recommended by the ADA for type 2 diabetes with obesity and symptomatic HFpEF, irrespective of A1C
what is tirzepatide?
Pearl: the 2026 Standards added a dedicated HFpEF recommendation for a dual GIP/GLP-1 RA in obesity-related HFpEF
Estimated average plasma glucose level: 240 (193-282)
what is A1c of 10?
ASCVD risk in diabetics is defined as
age >55 plus at least two of five risk factors. Name all five. Obesity, hypertension, tobacco use, dyslipidemia, and albuminuria
ADA recommendations for initiation of metformin (hint: 3 criteria)
What are BMI >35, A1C >6.0%, or FPG >110 mg/dl?
For a person living with HIV, name all three specific timepoints at which diabetes/prediabetes screening with an FPG test is recommended relative to antiretroviral therapy, and state the follow-up interval if that initial screening is normal.
What is before starting antiretroviral therapy, at the time of switching antiretroviral therapy, and 3–6 months after starting or switching - with annual FPG thereafter if normal?
This term describes escalating basal insulin beyond ~0.5 units/kg/day without meaningful FPG improvement while postprandial glucose stays high - a cue to add prandial insulin, not more basal
what is overbasalization?
Recite the AABBCC mnemonic used to distinguish type 1 from type 2 diabetes
What are Age, Autoimmunity, Body habitus, Background (family history), Control (achievable on non-insulin therapy), and Comorbidities (e.g., unintentional weight loss, DKA)?
DIAGNOSE
52 y/o pt with PMHx T2DM, CKD, HFpEF, alcohol use dx on metformin, farxiga, insulin 10u daily comes to ED lethargic and increased urinary frequency/urgency, after drinking 10 beers, did not eat day prior.
labs: glucose 168, B hydroxy+ 10, UA with 1+ ketones, AG 13
what is ALCOHOLIC KETOACIDOSIS?
- +/- euglycemic DKA
- HHS: BG 600 + pH > 7.3
- DKA: >200 + pH < 7.3
In T2DM with CKD and albuminuria already on a maximally tolerated ACE inhibitor/ARB, adding this nonsteroidal MRA improves cardiovascular outcomes and slows CKD progression
What is finerenone
You do not need to screen for diabetes after an episode of acute pancreatitis (T/F)
what is false? Screen people for diabetes within 3–6 months following an episode of acute pancreatitis and annually thereafter. Screening for diabetes is recommended annually for people with chronic pancreatitis.
ADA 2026 updated guidelines
Only DPP-4i requiring no CKD dose adjustment
what is linagliptin?
extra: saxagliptin and alogliptin worsen HF
This umbrella term describes diabetes arising from structural or functional damage to the exocrine pancreas - commonly misdiagnosed as type 2 diabetes - and is also known by two other names, one of which numbers it alongside type 1 and type 2. Name the preferred umbrella term and its two synonyms.
What is pancreatic diabetes — also called pancreatogenic diabetes or type 3c diabetes?
PEARL: can use pancreatic fecal elastase; absence of T1-associated autoimmunity